Obamacare won’t cause beheadings (does this really need to be said?)

A new rumor about Obamacare, formally known as the Affordable Care Act, making its rounds on the internet is that the law will make beheadingan official method of execution in the United States. The rumor, apparently has its origin in an article by Lorri Anderson on the Freedom Outpost on Nov. 18, 2013, about international medical codes. Conspiracy sites claim that a medical code for “legal execution” reveals that beheading and decapitation are coming to the United States. The Freedom Outpost is a conservative pseudo-news site that has articles on birtherism, nullification and otherconspiracy theories.

Anderson's article refers to a medical code, “ICD 9 E 978,” that conspiracy theorists believe purports to list the legal methods of execution in the United States. The definition of the coding is found on CentralX.com under “International Classification of Diseases” and is as follows:

E978 Legal execution

All executions performed at the behest of the judiciary or ruling authority
[whether permanent or temporary] as:
asphyxiation by gas
beheading, decapitation (by guillotine)
capital punishment
electrocution
hanging
poisoning
shooting
other specified means
INJURY UNDETERMINED WHETHER ACCIDENTALLY OR PURPOSELY INFLICTED

Anderson notes that the code is part of an international coding system, but doesn’t seem to understand what the codes are for or how they are used. She seems to believe that, because the United States is using the coding system, all parts of the code will apply to patients in the United States and that is is being forced on American doctors by the Department of Homeland Security and UN.

Writing for About.com, Trisha Torrey explains that “ICD” codes are “International Statistical Classifications of Diseases.” The codes are used to categorize every disease, set of symptoms or cause of death that can be attributed to human beings. The coding system was developed by theWorld Health Organization, the coordinating authority for health in the United Nations. As electronic medical records are implemented, the codes will be used for diagnosis and treatment of health problems.

When someone dies, an ICD code will also be used to record the cause of death. This is where Anderson’s code for “legal execution” comes in. The code will obviously be used when a person has been executed “at the behest of the judiciary or ruling authority [whether permanent or temporary].” Even though “beheading” and “decapitation (by guillotine)” are not legal methods of execution for the federal government or any of the 50 states, beheading is still legal in Saudi Arabia. Additionally, rebels in Syria and the Taliban in Pakistan (possibly a temporary authority in areas that they control) have been known to use beheading, as did Saddam Hussein in pre-war Iraq. Other Islamic terrorists have also been known to behead their captives. In one notable case, Nick Berg, an American business who was Jewish, was kidnapped and beheaded by Iraqi Muslim terrorists in 2004 and the video of the murder was posted online. And no, there is no evidence that Barack Obama is a Muslim.

Regardless of what international medical codes define as legal methods of execution, the method of legal execution in the United States is established by the legislature. According to the Death Penalty Information Center, 35 states plus the federal government have the death penalty. All states have lethal injection as the primary method of execution. In Georgia, lethal injection is the only legal means of execution. Federal law requires that in federal death penalty cases, the method of execution follows the law of the state in which the conviction took place. No state law permits execution by beheading.

Anderson also attempts to tie in the ICD coding to Agenda 21 by asserting that “WHO is a specialized agency of the United Nations and directly linked to the League of Nations under the guise of collecting data.” In reality, the League of Nations was the predecessor to the United Nations and was disbanded in 1946 after failing in its primary mission of preventing a second world war. The United Nations was founded a year earlier in 1945.

Agenda 21 (read the full text here) is frequent fodder for conspiracy buffs. Agenda 21 is a protocol for achieving “sustainable development” in the 21st century that was drafted by theUnited Nations Earth Summit in 1992. The agenda is not a treaty. The Heritage Foundation noted in 2011 that Agenda 21 is “voluntary” and “nonbinding.” The United Nations Associationagrees that Agenda 21 is “not legally binding” and “does not take precedence over U.S. law.” Agenda 21 passed the House of Representatives in 1992 (sponsored by Nancy Pelosi) according to the Library of Congress but was never passed by the Senate so it never became U.S. law.

Conspiracy proponents like Townhall.com columnist Rachel Alexander sometimes refer to Executive Orders that supposedly implement Agenda 21 without congressional approval. In reality, President Obama’s Executive Order 13575 which in 2011 established the White House Rural Council specifically says that “nothing in this order shall be construed to… affect… authority granted by law” and that the order “shall be implemented consistent with applicable law….” Obama’s Executive Order 13547 carries similar disclaimers to avoid in pretense of amending current federal law. Similar claims about other presidents are also farfetched. Two orders by Bill Clinton cited by conspiracy buffs (12852 and 12996) establish an advisory council for the president on sustainable development and create wildlife refuges on public use lands. George W. Bush is also blamed for Executive Orders 13423 and 13366, which are equally innocuous and also carry disclaimers that they do not amend existing law.

It takes little research to quickly determine that the Affordable Care Act will not implement beheadings in the United States. It can be determined almost as quickly that however ill-advised that Agenda 21 may be, it does not apply to the United States.

If you find an internet conspiracy theory that would like Examiner to investigate, contact the Atlanta Conservative Examiner at ThorntonDavid@yahoo.com or on the Common Sense Conservative Facebook page. If your conspiracy is selected for an article, you will receive an official Atlanta Conservative Examiner tinfoil hat. Readers might also be interested in Examiner’s guide to “Becoming a discerning internet user,” a helpful article on distinguishing fact from fiction on the internet.

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See my hat tip from Politifact

Obamacare facts: Death panels and rationing

The phrase “death panel” is a politically charged term that originated with Sarah Palin in 2009. Palin coined the term in reference to the Affordable Care Act’s requirement that Medicare pay for end-of-life counseling sessions. Her original Facebook post on the subject read, “The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care.” Factcheck.org called “death panels” one of 2009’s “whopper[s] of the year.”

The ACA does not contain the phrase “death panel” and the end-of-life counseling cited by Palin was not mandatory. This does mean that Palin was totally off the mark however.

The ACA does establish an unelected board of bureaucrats who will be tasked with cutting Medicare spending. According to a description of the Independent Payments Advisory Board (IPAB) in the New England Journal of Medicine, the board will consist of 18 appointed members (including three from the Department of Health and Human Services) and will be required to submit proposals to reduce per capita Medicare spending in years in which spending is projected to exceed target rates.

The NEJM notes that the IPAB is prohibited from rationing care, increasing copayments, restricting benefits or modifying eligibility criteria. One of its few options is the ability to cut payments to doctors and, after 2020, specific providers such as hospitals and hospices. Overriding the IPAB’s recommended payment cuts would require a three-fifths vote of the senate. This means that stopping the IPAB’s cuts would be very difficult and most likely require a bipartisan effort.

The NEJM also points out that currently the IPAB’s recommendations for payment cuts for transactions through private health insurance are not binding. These price controls on private medical transactions would have to be approved by Congress, which, the NEJM says, “may not be able to cap Medicare expenditures without addressing private expenditures as well.” This points to price controls for private medical costs as a means of controlling Medicare’s runaway costs.

A consequence of price controls is fewer available doctors. If providers cannot charge a market price, the supply of providers will decrease. This is already happening in Medicaid. The Wall Street Journal reports that 31 percent of doctors already do not accept new Medicaid patients because the entitlement pays them at a lower rate than private health insurance companies.

Price controls are effectively a form of health care rationing. As price controls cause shortages, allotting the available care will fall increasingly fall upon government bureaucrats.

Rationing is the inevitable outcome of price controls and shortages. Donald Berwick, the administrator of the Centers for Medicare and Medicaid Services, said in an Associated Press interview, “The decision is not whether or not we will ration care. The decision is whether we will ration with our eyes open. And right now, we are doing it blindly.” President Obama appointed Berwick during a senate recess to avoid confirmation hearings.

Other countries with government administered health care have followed the price control and rationing model. Canada’s universal health care system has led to long wait times “for practically any procedure or diagnostic test or specialist consultation in the public system” according to the Wall Street Journal. In Canada, only half of ER patients are treated “in a timely manner by national and international standards.” Perhaps this is why the premier of the Canadian province of Newfoundland came to the United States in 2010 when he had to have heart surgery instead of going to a Canadian hospital. In fact, many emergency patients in border areas are sent to U.S. hospitals for treatment.

In England, the Daily Mail reported in 2008 that a government edict to treat patients within four hours of check-in had led hospitals to keep patients in ambulances for up to five hours before being allowed access to the emergency room. The four hour wait as measured by the government did not begin until the patients left the ambulance and entered the hospital. Over 45,000 patients waited more than one hour for access to the emergency room. Leaving patients in ambulances also means that the ambulances are not available for new calls.

In 2011, the Independent reported that budget cuts were forcing the British National Health Service to overtly ration health care. Two-thirds of the national health trusts in the U.K. are rationing treatments for “non-urgent” procedures. Examples of rationing include only allowing hip and knee replacements for patients in severe pain, delaying cataract surgery until the patient’s sight is substantially affected, requiring seven cases of tonsillitis within a year before allowing children to have a tonsillectomy, and mandating “exceptional circumstances” and six months of monitoring before inserting “grommets” in a child’s ears to improve hearing.

These economic laws hold true even in the United States. In Massachusetts, which has been cited as the prototype for Obamacare, the Boston Globe reported in November 2011 that tiered health plans with limited networks that force consumers to endure long wait times or pay more out-of-pocket to be treated sooner are becoming more common in the state. An analysis by the Cato Institute found that since Massachusetts enacted health care reform wait times have increased. Wait times for a doctor’s appointment in Boston, already longer than other metropolitan areas before the reform, have increased while they have improved in other cities. Health care costs in Massachusetts have increased faster than the national average and adverse selection, the sickest people choosing the best insurance plans, has led some insurers and employers to stop offering the most comprehensive plans.

Earlier this month, Massachusetts Governor Deval Patrick signed a health care price control bill into law. The New York Times reports that the new law will cap both public and private health care spending “so that it will grow no faster than the state economy.” The law sets up a commission to monitor increases in spending. The commission can demand an explanation from providers or insurers whose costs exceed the target rate. It can also fine organizations up to $500,000 if it finds that they did not make a good faith effort to reduce costs.

A 2009 Rasmussen poll indicated that only 32 percent believed that Massachusetts health care reform was a success. A more recent WBUR poll found that 78 percent still consider health care costs a significant problem for Massachusetts. Sixty-three percent say that costs have gotten worse over the past five years since the reform was enacted.

The discussion of quality adjusted life years brings the discussion of rationing full circle back to Palin’s original quote. Quality adjusted life years (QALYs) is a calculation that measures “the benefits gained from a variety of medical procedures in terms of quality and life and survival for the patient” according to Oxford University’s Bandolier Journal.

While the ACA currently forbids the use of QALYs “to determine coverage, reimbursement, or incentive programs,” an article in the New England Journal of Medicine is openly critical about the law’s prohibition, saying that the “notion that the country can avoid the difficult trade-offs that cost-utility analysis helps to illuminate” is “magical thinking.” If the law were amended to allow the use of QALYs, it might mean that older patients would be unable to receive certain surgeries because the procedure offered more benefit to younger people. It might also mean that babies like Trig Palin would be passed over for people in a more productive stage of life.

As the demand for health care increases due to more people being covered with health insurance, there are certain to be shortages since the supply of doctors and hospitals is not increasing. Rationing and shortages in such situations commonly take the form of long wait times for treatment and price controls. This has occurred in a multitude of other countries where government-controlled health care has been tried. Given the shoddy, backroom manner in which the ACA was written, it is unlikely to contain any new and different approaches that will work where previous government health care bureaucracies failed.

President Obama and the Democrats may have been able to pass the Affordable Care Act and get it past the Supreme Court. As yet, they have been unable to repeal the laws of economics.

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